Disparities in prostate cancer care exist by healthcare provider
MedWire News: Patients diagnosed with prostate cancer at private hospitals in the UK have an earlier disease stage at diagnosis, are more likely to be treated with surgery, and less likely to receive radiotherapy than those diagnosed at National Health Service (NHS) hospitals, study findings indicate.
"However, substantial socioeconomic differences in stage and treatment persist even after adjustment for hospital of diagnosis category, indicating that in major part these differences relate to factors other than private healthcare use," remark Gergios Lyratzopoulos (University of Cambridge, UK) and colleagues in the Journal of Public Health.
The researchers explain that the UK's NHS is a public healthcare system, funded via general taxation, that provides free, comprehensive healthcare. A smaller private healthcare sector funded on a pay-as-you-go basis or via medical insurance also exists in the UK.
It is already known that socioeconomic differences exist in prostate cancer screening, incidence, and management, and private healthcare may contribute to these inequalities.
To investigate whether this is the case in the UK, Lyratzopoulos and team examined population-based cancer registry information on 14,914 (94% of those registered) prostate cancer patients diagnosed in NHS hospitals, and 818 (5%) diagnosed in private hospitals during 1998-2006.
They report that patients diagnosed in private hospitals were significantly more affluent (69 vs 52% in the lowest two deprivation quintiles), younger (mean 69 vs 73 years), and diagnosed at earlier stage (72 vs 79% in stages I-II) than those diagnosed in NHS hospitals.
After adjustment for age, deprivation category, and diagnosis period, being diagnosed in a private hospital was significantly and independently associated with a 25% lower probability for advanced disease stage (stages III-V), a 28% higher probability for surgery use, and a 25% lower probability for radiotherapy use.
When the researchers accounted for significant interactions between hospital type and deprivation category, and between hospital type and age, they found that diagnosis in a private hospital still independently predicted greater use of surgery and lower use of radiotherapy, particularly in more deprived patients aged 70 years and younger.
These findings indicate that, in the UK, "private care use is a relatively minor cause of overall socioeconomic differences in the diagnosis and treatment of prostate cancer," the researchers remark.
"This is because although access to private healthcare is strongly patterned socioeconomically, only a minority of patients actually used such care, at least until recently. Therefore, in major part, prostate cancer inequalities occur within the larger group of patients cared by the public (NHS) sector," they add.
Lyratzopoulos and team conclude: "In spite of uncertainties and inconsistent evidence about the potential benefit of prostate cancer screening and optimal management strategies, treatment disparities are a cause for concern, as they can indicate variable quality of patient information and consent processes, or variable availability of expertise and resources."
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By Laura Cowen